ADHD

Question 1

ADHD encompasses the triad of what difficulties?

Answer 1

inattention
hyperactivity
impulsivity

Question 2

ADHD is frequently co-occurring with a cluster of impairing symptoms relating to what?

Answer 2

self regulation (ie executive functioning, emotional regulation)

Question 3

what are the main impacts in childhood ADHD?

Answer 3

difficulties parenting 
increased level of home stress
difficulties in peer relationships
poor problem solving ability 
barrier to learning 
antisocial behaviours

Question 4

what are the main impacts in adult ADHD?

Answer 4

increased psychiatric comorbidity
criminality, antisocial behaviour
substance misuse
impairment in occupation function that could be accommodated for if diagnosis known

Question 5

what is the theory behind the fact most adults will still have residual symptoms of ADHD but will no longer meet diagnostic criteria?

Answer 5

possibly because there is an improvement in cortical thickness (maturation) that allows for the brain to compensate for cognitive deficits

Question 6

what three factors are thought to contribute to causing ADHD?

Answer 6

perinatal precipitants
genetic predisposition
psychosocial adversity

*results in neuroanatomical brain changes which causes the cognitive and behavioural features of ADHD

Question 7

by around what % is there an increased risk for ADHD among the offspring of adults with it?

Answer 7

60

Question 8

by what % is there an increased risk for ADHD among the siblings of children with ADHD?

Answer 8

15

Question 9

mainly what genes are involved in ADHD?

Answer 9

dopamine and serotonin transporter genes

Question 10

what perinatal factors are thought to increase risk of ADHD?

Answer 10

tobacco and alcohol use
prematurity and perinatal hypoxia
unusually short or long labour, foetal distress, low forceps delivery and eclampsia

Question 11

what psychosocial adversity is thought to increase risk of ADHD?

Answer 11

particular parenting styles
severe marital discord, low social class, large family size, paternal criminality, maternal mental disorder, maltreatment and emotional trauma

Question 12

what does a typical brainmap pattern seen in children with ADHD show?

Answer 12

under active function within frontal lobe

*frontal lobe responsible for reasoning, planning, impulse control, judgement, initiation of actions, social / sexual behaviour and long term memory

Question 13

what is thought to be the neurochemistry behind ADHD?

Answer 13

excessively efficient dopamine removal system

reduction of norepinephrine (can affect attention when acting as stress hormone) and serotonin (which influences mood, social behaviour, sleep and memory)

Question 14

how is an assessment for ADHD carried out in children?

Answer 14

mainly driven by parents/school
ideally a school observation
screening and diagnostic questionnaires
background info regarding risk factors including developmental hx
exploration of early history and attachment style

Question 15

how is an assessment for ADHD carried out in adults?

Answer 15

driven by patient
historical concerns present
specific adult screening tools available
current clinical picture should be consistent with ADHD (not just past)
cognitive difficulties and ability to function need evaluation

Question 16

what is the diagnostic criteria for ADHD in children?

Answer 16

6 or more symptoms of inattentiveness and/or
6 or more symptoms of hyperactivity and impulsiveness
present before age 5 (or 3 for some clinicians)
reported by parents, school and seen in clinic
symptoms get in way of daily life

Question 17

what is the diagnostic criteria for ADHD in adults?

Answer 17

disagreement about whether symptoms used to diagnose children also apply

in general, 5 or more of the symptoms of inattentiveness and/or
5 or more symptoms of hyperactivity and impulsiveness

historical concerns since early age

Question 18

for adults, it is essential for the diagnosis that symptoms should have effect on different areas of life such as what?

Answer 18

underachieving at work or in education
driving dangerously
difficulty making or keeping friends
difficulty in relationships with partners

Question 19

what psychosocial interventions should take place in those with mild, moderate and severe ADHD?

Answer 19

parent training (ie new forest parenting programme)
social skills training
sleep and diet: eliminations and supplements
behavioural classroom management strategies
specific educational interventions

Question 20

what are the 1st line drugs for moderate and severe ADHD?

Answer 20

methylphenidate - increase dopamine by blocking transporter

dexamfetamine - as above but also increases extracellular norepinephrine and serotonin

lisdexamfetamine

*these are stimulants

Question 21

what is the 2nd line drug for moderate and severe ADHD?

Answer 21

atomoxetine - increases norepinephrine by blocking its transporter

*these are SNRIs

Question 22

what are the 3rd line drugs for moderate and severe ADHD?

Answer 22

clonidine
guanfacine

*these are alpha agonists - reduces sympathetic stimulation

Question 23

what are the 4th line drugs for moderate and severe ADHD?

Answer 23

antidepressants (imipramine)

antipsychotics (resperidone)